The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective

Abstract

To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities. Iterative qualitative and quantitative investigations. The community catchment area of a metropolitan Australian tertiary public hospital. Patients aged over 65 years, with a range of conditions, recently discharged from hospital, their carers, and hospital nursing staff. PREPARED was constructed from interviews with patients, carers and hospital staff. It was trialed and modified to ensure sensitive measurement of key attributes of discharge planning process and outcome. This paper explores the patient and carer versions of PREPARED. Data items were reduced to domains of key questions by factor analysis. Instrument performance was assessed by correlation of process and outcome measures, by comparing PREPARED responses with subsequent unstructured interview data, and by testing whether PREPARED responses were independent of health-related quality of life at the time of survey. Four key process domains were identified: information exchange (community services and equipment), medication management, preparation for coping after discharge and control of discharge circumstances. Outcome was measured as overall satisfaction with discharge, whether equipment and community service needs had been met, use of health services and health related costs post-discharge. The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36. PREPARED offers a comprehensive way of closing the quality improvement loop, by providing information from the community perspective on the quality of planning for discharge from the acute hospital setting.